肠道菌群移植对重症肺炎恢复期患者及其肠道微生态影响的初步研究  

A preliminary study on the effects of fecal microbiota transplantation on the intestinal microecology of patients with severe pneumonia during the convalescence period

作　　者：钟佩燕 许怡梦 叶世贤 杨峰[1] 吴璐璐[1] 苏冠升 刘雨欣 冯嘉杰 王玉[4] 吴镇宇 郑则广[1] Zhong Peiyan;Xu Yimeng;Ye Shixian;Yang Feng;Wu Lulu;Su Guansheng;Liu Yuxin;Feng Jiajie;Wang Yu;Wu Zhenyu;Zheng Zeguang(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou Institute of Respiratory Health,State Key Laboratory of Respiratory Diseases,National Clinical Research Center for Respiratory Diseases,Guangzhou 510120,Guangdong,China;Department of General Practice,Shenzhen Third People's Hospital,Shenzhen 518112,Guangdong,China;Department of Internal Medicine,Shunde Hospital Affiliated to Southern Medical University,Foshan 528399,Guangdong,China;Henan University,Kaifeng 475004,Henan,China)

机构地区：[1]广州医科大学附属第一医院呼吸与危重症医学科,广州呼吸健康研究院,呼吸疾病国家重点实验室,国家呼吸系统疾病临床医学研究中心,广东广州510120 [2]深圳市第三人民医院全科医学科,广东深圳518112 [3]南方医科大学附属顺德医院内科,广东佛山528399 [4]河南大学,河南开封475004

出　　处：《中华危重病急救医学》2023年第4期352-357,共6页Chinese Critical Care Medicine

基　　金：国家自然科学基金(81873408);广东省基础与应用基础研究自然科学基金(2021A1515012201);广东省广州市校(院)联合资助基础与应用基础研究项目(202201020435)。

摘　　要：目的探讨肠道菌群移植(FMT)对重症肺炎恢复期患者肠道微生态和机体的影响。方法采用前瞻性非随机对照研究方法,选择2021年12月至2022年5月广州医科大学附属第一医院收治的接受FMT的重症肺炎恢复期患者(FMT组),以及同期住院未接受FMT的重症肺炎恢复期患者(非FMT组)。比较两组患者入组前1 d和入组后10 d临床观察指标、胃肠道功能及粪便性状等差异。采用16S rDNA基因测序技术分析FMT组患者入组前后肠道菌群多样性及差异物种的变化,并进行京都基因与基因组百科全书数据库(KEGG)代谢通路分析预测;采用Pearson相关法分析FMT组患者肠道菌群与临床观察指标的相关性。结果FMT组患者入组后10 d三酰甘油(TG)水平较入组前显著降低〔mmol/L:0.94(0.71,1.40)比1.47(0.78,1.86),P<0.05〕;非FMT组患者入组后10 d高密度脂蛋白胆固醇(HDL-C)水平较入组前显著降低(mmol/L:0.68±0.27比0.80±0.31,P<0.05)。两组患者其他临床观察指标、胃肠道功能及粪便性状评分等在入组前后差异均无统计学意义。多样性分析显示,FMT组患者入组后10 d肠道菌群α多样性指数均显著高于非FMT组,且β多样性亦与非FMT组存在显著差异。差异物种分析显示,与入组前比较,FMT组患者入组后10 d肠道菌群门水平中变形杆菌门相对丰度明显降低〔8.554%(5.977%,12.159%)比19.285%(8.054%,33.207%),P<0.05〕,梭杆菌门相对丰度明显升高〔6.801%(1.373%,20.586%)比0.003%(0%,9.324%),P<0.05〕;肠道菌群属水平中丁酸单胞菌属、梭杆菌属及双歧杆菌属等相对丰度均明显升高〔丁酸单胞菌属:1.634%(0.813%,2.387%)比0%(0%,0.061%),梭杆菌属:6.801%(1.373%,20.586%)比0.002%(0%,9.324%),双歧杆菌属:0.037%(0%,0.153%)比0%(0%,0%),均P<0.05〕。KEGG代谢途径通路分析显示,FMT组患者肠道菌群在双酚降解、矿物质吸收、磷酸盐和次磷酸盐代谢、心肌收缩及帕金森病等代谢通路与疾病中发生改变。相�Objective To investigate the effects of fecal microbiota transplantation(FMT)on intestinal microbiome and organism in patients with severe pneumonia during the convalescence period.Methods A prospective non-randomized controlled study was conducted.From December 2021 to May 2022,patients with severe pneumonia during the convalescence period who received FMT(FMT group)and patients with severe pneumonia during the convalescence period who did not receive FMT(non-FMT group)admitted to the First Affiliated Hospital of Guangzhou Medical University were enrolled.The differences of clinical indicators,gastrointestinal function and fecal traits between the two groups were compared 1 day before and 10 days after enrollment.The 16S rDNA gene sequencing technology was used to analyze the changes of intestinal flora diversity and different species in patients with FMT before and after enrollment,and metabolic pathways were analyzed and predicted by Kyoto Encyclopedia of Genes and Genomes database(KEGG).Pearson correlation method was used to analyze the correlation between intestinal flora and clinical indicators in FMT group.Results The level of triacylglycerol(TG)in FMT group was significantly decreased at 10 days after enrollment compared with before enrollment[mmol/L:0.94(0.71,1.40)vs.1.47(0.78,1.86),P<0.05].The level of high-density lipoprotein cholesterol(HDL-C)in non-FMT group was significantly decreased at 10 days after enrollment compared with before enrollment(mmol/L:0.68±0.27 vs.0.80±0.31,P<0.05).There were no significant differences in other clinical indexes,gastrointestinal function or fecal character scores between the two groups.Diversity analysis showed that theαdiversity indexes of intestinal flora in FMT group at 10 days after enrollment were significantly higher than those in non-FMT group,andβdiversity was also significantly different from that in non-FMT group.Differential species analysis showed that the relative abundance of Proteobacteria at the level of intestinal flora in FMT group at 10 days aft

关 键 词：肠道菌群移植 重症肺炎 恢复期 肠道微生态 

分 类 号：R563.1[医药卫生—呼吸系统]